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Archive for November, 2010

In my most recent column, I discussed the topic of rabies, especially what one should do if bitten by a possibly rabid animal. Now, I would like to describe animal bites in general.

The law requires that the local animal control office be contacted when any person or animal is bitten by another animal, whether the biting animal is wild or domestic. The phone number for the local Santa Cruz animal control office is 454-7303.

When a bite victim seeks medical treatment, the treating physician must also, by law, fill out an animal bite form and send it immediately to animal control. That is true even if the bite is from one’s own pet. An animal control officer will investigate and advise the animal owner about quarantining the animal, which is usually done at the owner’s home. Regardless of the animal’s vaccination history, it will be observed daily for 10 days following the bite for signs of rabies. If the isolated dog or cat is deemed healthy after 10 days, there is no risk of rabies from the original bite wound, and the bitten victim will not need to undergo the series of shots to prevent rabies.

Some animal bite statistics to consider:

More than 3 million animal bites are reported each year.

Emergency rooms see 300,000 animal-bite-related visits each year, costing about $160 million.

Eighty percent of bites are from dogs, 10 percent from cats and remaining 10 percent from other animals.

Children are the most frequent victims of dog bites, especially boys between 5 and 9 years old.

At least 50 percent of dog bites are from a family dog or a dog belonging to a neighbor.

Men are more frequently bitten by dogs than women (3 to 1), and women are more frequently bitten by cats (3 to 1).

Dog owners should be aware that many homeowner insurance policies will not cover certain biting-prone dog species and will often drop coverage or increase premiums after a single dog bite.

In general, dog bites cause less infection than cat bites. This is because dogs’ teeth are duller and less able to penetrate the flesh deeply, while cats’ teeth are sharper, proportionally longer and able to sink deeper. Infections are often evident after fewer than 24 hours.

Bites to the face, although cosmetically worrisome, are least prone to infection, and bites to the hands and fingers are most likely to become infected.

Seek medical treatment immediately for a bite anywhere on the body from any animal if:

**The wound is gaping (wide open).

** The wound won’t stop bleeding. (Always apply pressure first.)

**You have cosmetic concerns.

**You have a weakened immune system.

**The wound already appears infected.

**You need a tetanus booster.

I want to emphasize that if you have suffered what you believe to be more than just a superficial to bite to the hand from any source, be it a dog, a human, or especially a cat, see your doctor for wound evaluation and treatment as soon as possible.

You will most likely be treated with antibiotics before an infection develops. Hand infections — especially from bites — may be a cause for hospitalization if not treated promptly and aggressively.

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Two bats with rabies have recently been found in a Scotts Valley neighborhood. Is this cause for alarm? Not really, but it calls for a heightened awareness of what rabies is, how it is transmitted and what needs to be done for a known exposure.

Rabies is an infection caused by a virus. It is usually passed on to humans through the bite of a rabid (that is, rabies-infected) animal. Rarely, it can be transmitted if the saliva of an infected animal comes in contact with a break in the skin, such as a scratch, or with mucus membranes, such as the eyes, mouth or nose.

Once the virus enters a body, it travels along a nerve to the spinal cord and brain, where it causes encephalitis (brain infection). Once this happens, it is usually 100 percent fatal. That’s what makes this such a serious, although thankfully rare, disease. Although it might take one to three months for symptoms of rabies to show up, immediate treatment is necessary.

Rabies causes as many as 35,000 deaths worldwide each year, mostly in developing countries. Due to effective animal control and vaccinations begun in the 1940s, the incidence of rabies in our domestic animals in the U.S. has decreased dramatically. Dogs and cats now account for only 3 percent of animal rabies. Contrary to common thinking, cats are more rabies-prone than dogs. However, the incidence of rabies among wild animals has increased and poses our greatest concern.

To show how rare this disease is, the last case of human rabies reported from an exposure in California was in 2003. Although any mammal could be infected with rabies, in California, it is usually found in bats, skunks and, to a lesser extent, foxes. It is extremely rare in rodents, such as squirrels, rats, mice and chipmunks.

If you have been bitten by a possibly rabid animal, wash the wound immediately with soap and water. Then get professional treatment.

In Santa Cruz County, the only option for immediate treatment is a visit to the Dominican Hospital emergency room. This facility stocks a medication called “human rabies immune globulin,” which is an injection that must be given as soon as possible after a rabies exposure to protect your body from developing the infection. At the same time, you will be given the first of five necessary rabies vaccines, which will continue over the course of a month. These shots are given in the arm. This is a vast improvement from the much-feared older method of giving 20 to 30 shots in the abdomen.

After the initial emergency room treatment, I would advise that you immediately call your health insurance provider to see if the next four vaccine shots will be covered by insurance, and if so, you could go to most any urgent-care clinic for the necessary treatment.

For those without insurance, the local county health clinic on Emeline Avenue also stocks the necessary post-exposure vaccine. They charge $215 for each of the four injections and a nominal nursing visit charge to give the injection. The county clinic just needs an order from a physician for the clinic nurse to give the shots. Call 454-4114 to arrange this treatment, and remember that the timing is critical.

My next column will discuss how animal bites are reported to the authorities and what pet owners need to know if their pet has bitten someone or has been bitten by a possibly rabid animal.

Signs an animal might have rabies

**A wild animal seems unusually tame or unafraid and approaches you.

**A nocturnal animal, such as a bat or skunk, is found outdoors during the daytime.

**A pet develops difficulty eating, drinking, walking, or acting unusually strange.

**A bat is unable to fly or has been caught by a domestic dog or cat.

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Sinuses are air pockets found in the bones of the skull. There are seven sinuses which are located on both sides of the nose, in between the eyes, and one deep behind the nose. Their true function is not well understood, but some have suggested that sinuses serve to lighten the weight of the skull, to humidify the air we breathe and to create resonance in our voices.

Acute sinusitis is an inflammation of the sinuses. This in turn causes the lining of the sinuses to become swollen. The swelling interferes with drainage of sinus fluid, thus filling up the space, which causes the typical pain. It is usually triggered by the common cold virus and less often by seasonal allergies (hay fever).

Sinus infections affect more than 30 million adults in the U.S. every year and cost the health care system about $3 billion to diagnose and treat.

Those who experience hay fever or any allergic condition that affects the sinuses are more at risk for sinusitis. Risk factors also include exposure to pollutants, such as cigarette smoke, and nasal passage abnormalities, such as a deviated septum or nasal polyps.

Common symptoms of a sinus infection are:

* Nasal obstruction with drainage of thick yellow or green mucus

* Pain, tenderness, swelling and pressure around the eyes or aching in the upper teeth

* Reduced sense of smell and taste

* A cough, often worse at night

If the above symptoms are combined with a fever greater than 100.5 degrees Fahrenheit, unbearable facial pain, or swelling and redness around the eyes and nose, that’s a reason to see a doctor immediately for a possible sinus infection.

Recommendations for treatment to relieve the symptoms include:

* Saline nasal irrigation: Over the past few years, since I have become familiar with this treatment, I have seen countless patients with sinus infections that might have needed antibiotics cure their infections with saline irrigation. “Neil Med” sells a rinsing system for less than $15 and can be found at all pharmacies.

* Decongestants: This includes over-the-counter medication, such as Sudafed. (Have the pharmacy tech help you find the generic alternative with the ingredient “pseudoephedrine.”) There are also nasal sprays, such as Neo-Synephrine or Afrin, either of which should be used for no more than one week. Remember to always read the labels on medications before using them.

* Nasal steroids:. These medications, which can be obtained with a doctor’s prescription, include Flonase and Nasonex, among others, and are used to prevent and treat nasal inflammation.

Because sinusitis is usually caused by a virus, my advice for those who have symptoms of a sinus infection is to treat the symptoms as outlined above for a week or two. Then, if symptoms worsen or do not improve, see a doctor.

When you do so, don’t expect or ask to be prescribed antibiotics. Just tell the doctor your symptoms and let him or her examine you and offer the treatment he or she feels is in your best interest. This might or might not include antibiotics. Trust your doctor’s advice.

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Acute bronchitis, an infection causing inflammations of the lung’s airways, is one of the most common of human ailments.

It usually begins with head cold symptoms, such as a runny nose, sinus congestion or a sore throat. It is almost always caused by a virus and rarely by bacteria. If a cough is not caused by pneumonia, influenza or asthma, it is most likely a symptom of bronchitis.

Most people actually feel fairly well with bronchitis, except for having a persistent cough. Fever is rare with bronchitis, and mucus production may or may not be present.

A very common misperception is that colored mucus, especially green, indicates a bacterial infection and therefore the need for antibiotics. Recent scientific evidence overwhelmingly supports that virus infections also produce green mucus, and viruses are treated not with antibiotics, but rather by one’s own immune system.

Those who smoke are much more susceptible to bronchitis, because of the damage done by the smoke to the lining of the breathing tubes; therefore, germs can enter the lungs more easily, causing an infection.

Many patients request antibiotics in hopes of quickly ridding themselves of the cough and therefore visit their doctor as soon as symptoms begin so that they may “nip it in the bud.” Some think that antibiotics helped them on previous occasions, but there is no proven benefit for these drugs in the treatment of bronchitis. Inappropriate antibiotic use can cause unnecessary side effects, increase the cost of medical care and lead to the development of resistant germs.

Treatment for bronchitis should be directed toward relieving the symptoms.

For the head cold symptoms that go with bronchitis, Tylenol (acetaminophen) or Advil (ibuprofen) can be used for the relief of aches and pains. An oral decongestant pill, such as Sudafed (pseudoephrine), as well as a decongestant nasal spray, such as Afrin (oxymetazoline hydrochloride), can be used to combat nasal and sinus congestion. Afrin spray is usually very effective, but it should not be used for more than a week to avoid rebound (worsening) congestion.

Drinking plenty of liquids has proven to be very effective to keep the mucus loose. For cough symptoms, over-the-counter cough medicines with dextromethorphan, such as Robitussin DM or Vicks 44, may be helpful.

If one ends up at the doctor’s office, a prescription cough medication may be prescribed. A cough suppressant, especially if taken at bedtime, will not interfere with the healing process. Also, for a cough associated with wheezing, a doctor may prescribe a brief course of an inhaled medication commonly used for asthmatics.

In summary:

**Bronchitis is caused by a virus, and antibiotics are almost never necessary

**The cough of bronchitis often lasts 10 to 20 days.

**For aches and pains, Tylenol or Advil

**For nasal or sinus congestion, Sudafed or Afrin nasal spray

**For cough relief, Robitussin DM or Vicks 44

See your doctor if you have any significant worries regarding your symptoms, but especially if your cough is associated with a fever of greater than 38 degrees Celsius or 100½ degrees Fahrenheit, or if you have chest pain or trouble breathing.

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Patients who go to a doctor complaining of heart palpitations usually worry that they have some serious problem with their heart. They often describe a feeling that their hearts are “flip-flopping,” missing a beat, beating faster or beating irregularly.

Palpitations, whether harmless (as most of them are) or serious, should not be ignored. A medical evaluation is recommended, especially if they are associated with dizziness, shortness of breath, chest pain or fainting.

Palpitations are usually caused by the heart beating too soon before the next normal beat. When this happens, one feels a “flip-flop” sensation in one’s chest. Because the palpitation is only a skipped beat, the heart can still function normally, so there’s usually no health risk.

Quite often, a cause for palpitations is not found, but there are some known factors:

*Strong emotional responses, such as anxiety, stress or fear

*Use of caffeine, nicotine or alcohol

*Cold and cough medications that contain the decongestant pseudoephedrine (Sudafed), which can act as a stimulant

*Strenuous exercise

In rare cases, palpitations might be a sign of a potentially serious heart problem that requires treatment. Serious complications of palpitations can include the following:

*Fainting from a significant drop in blood pressure.

*Stroke from causing lack of oxygen rich blood to the brain.

*Heart failure from the heart pumping ineffectively.

*Cardiac arrest from a heart beating so irregularly that blood circulation stops.

A medical evaluation for palpitations will usually involve a physical exam, blood tests, and an electrocardiogram. The doctor might also order a portable heart monitor to be worn for 24 to 72 hours, which can detect palpitations not found on an EKG. The bottom line is that heart palpitations are usually more bothersome than they are serious, but it’s wise to check with a doctor, just to be safe.

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